Managing a migraine

Migraine management has moved on since the days when a sufferer’s only option was to pop a pill and lie down in a dark room, waiting for the cranial storm to pass. Yet understanding this common neurological condition has confounded and eluded scientists for centuries, with the resultant ‘golden ticket’ being prevention rather than cure.

Recent thinking, however, has opened up a whole new approach to assist the one billion sufferers affected worldwide. Read on for information on tackling triggers, plus symptoms and strategies to make headway with the condition that’s so much more than just a headache. 

US President Jefferson wrote to a confidante in the spring of 1807, “I have but a little moment in the morning in which to read, write or think”, referring to the periodical headache, now thought to be a migraine, which wrote off the afternoons of his second term in office, confining him to a dark room until nightfall. 

More than two centuries later, one in seven of the world’s population feels much the same way, with 190,000 migraine attacks per day in the UK alone, the cost to the British economy is estimated to be around £3.42 billion per annum (based on the cost of the 25 billion days lost through absenteeism), and the unpredictable, episodic characteristic of the condition presenting a challenge for the employee and employer alike.

Ranked 7th on the list of the world’s most disabling conditions, and more common than asthma, diabetes and epilepsy combined, migraine costs the NHS £150 million annually, with spending predominantly on prescription drugs for the UK’s six million sufferers.

Yet some cases remain undiagnosed, and at the other end of the spectrum, pain relief overuse may result in rebound headaches, adding to a sufferer’s burden. Concentration and sleep can be disrupted, with appetite and mood affected due to accompanying nausea and increased sensitivity to bright light often likely to continue between attacks. Clearly, looking to tackle migraine from a nutritional perspective makes sense; offering hope and relief through diet and lifestyle management.  

Possible migraine triggers

Hormonal fluctuations during puberty, pregnancy, menstruation, menopause, or because of HRT or the contraceptive pill may induce symptoms for the first time or worsen an attack. In nine out of ten cases, there’s a family tendency to a migraine, with women three times more likely to suffer than men, due to oestrogen fluctuations.

But even if your genes have dealt you a poor hand, many of the factors resulting in migraine onset are eminently modifiable. Factors thought to increase the frequency and intensity of attacks include:

• smoking
• oral contraceptives
• poor sleep patterns 

Several cross-sectional studies also note that obese individuals are three times as likely to have an attack than those of regular weight, with symptoms worsening in line with increasing BMI. This is thought to be due to the excess adipose tissue secreting substances which promote an inflammatory response.

The relationship between migraines and nutrition

Gut bacteria are also thought to play their part – with the brain and gastrointestinal (GI) tract strongly linked along with various brain, endocrine and immune pathways, and disturbances in gut microbiota or bacteria leading to intestinal permeability (otherwise known as ‘leaky gut’) with an inflammatory response, that can result in migraine onset.

Ironically, painkillers such as aspirin or non-steroidal anti-inflammatory drugs (NSAIDs) are regularly prescribed to alleviate migraine symptoms such as pain and inflammation, but they can act as gut irritants, severely hampering GI health and often resulting in nutrient malabsorption. This can have a knock-on effect, as any disturbances in magnesium and calcium processing can result in brain cells getting worked up into a frenzy known as ‘hyper-excitability’, the very process thought to reduce tolerance threshold.

Food in the form of salty snacks, processed meals filled with additives such as aspartame or MSG, as well as aged cheeses (due to the presence of a substance called tyramine which affects blood vessels) should be avoided. Nitrates in processed meats and sulfites from dried fruits and salad bar foods are also off the menu. Wine can also be a trigger; sulfites are the culprit here too. Artificial sweeteners found in fizzy soft drinks also a no-no. Missing meals, eating at irregular times or undertaking fasting diets can interfere with blood sugar levels, inducing a migraine, as can becoming dehydrated - so aim to eat and drink at regular intervals through the day.

Managing stress and migraines

When it comes to tackling stress, try massage, meditation or any relaxation techniques that work for you! Exposure to the sunshine or other bright lighting, strong smells and intense physical exertion can also make matters worse as can changes in weather or humidity levels and variations in the sleep/wake cycles eg. lying in at the weekend.
 
While noting personal ‘flash-points’ can help to keep track and prevent onset by flagging up risky foods, times or situations, looking to lifestyle, food and supplements to lessen migraine onset and treat symptoms when they do occur is also fundamental.

Diet for migraines - cause and prevention

With regards to gut health, removing potential irritants including gluten, caffeine, alcohol and sugar (even temporarily) can help the gut to heal while preventing exposure to migraine-triggers in a nutritional, two for the price of one approach. European studies have reported increased incidence of migraine among coeliac disease sufferers, with removal of gluten as part of an elimination diet linked to a notable reduction in amount, duration and severity of a migraine, it’s thought to reduce gut permeability and resultant inflammation. 

Introducing nuts, seeds, vegetables, gluten-free grains such as quinoa, buckwheat, rice and pulses including beans, lentils and peas can help to ‘crowd out’ gluten-rich, refined carbs in the diet, while also providing a valuable source of fibre. Thus replenishing and feeding the ‘good’ bacteria and simultaneously improving the diversity of microbiota in the gut. 

Probiotics are also recommended and have been demonstrated to enhance and strengthen the gut lining, working to fortify the body’s defensive capabilities, as well as increasing its ability to absorb nutrients more efficiently and effectively to help rebalance hormone levels.
 
A diet low in refined carbs can also help to stabilise blood sugar levels throughout the day, essential as fasting or going too long between meals is thought to induce a migraine with some migraineurs experiencing a blood sugar slump due to diet-induced increased insulin levels. A diet rich in vegetables, fruits, beans, free-range or organic protein plus healthy fats from wild salmon, seeds and nuts as well as olive oil to keep blood sugar stable is recommended. 

Talking to your doctor about your migraine

So while each and every sufferer may experience a migraine in a different way, combining dietary strategies with adequate rest, relaxation, hydration and gentle exercise (when tolerated) as well as avoiding known triggers, may be more helpful than pill-popping and retreating into the darkness when it comes to managing the pain in the brain we call a migraine.
 
You may also like to consider seeing a nutritional therapist for dietary information and personal, targeted advice regarding migraines. Keep your GP informed of your progress and any supplements you start taking. It’s also important to consult a GP if the following is experienced:

• Abrupt, thunderclap type headache.
• A headache accompanied by high temperature and stiff neck.
• A headache that worsens after a head injury.
• Sudden headache onset, especially for the over 50s.

References

Migraine Research Foundation (2017). Migraine facts. [online] Available at: https://migraineresearchfoundation.org/about-migraine/migraine-facts/  

More than "just a headache" (2017) The Migraine Trust. [online] Available at: https://www.migrainetrust.org/about-migraine/migraine-what-is-it/more-than-just-a-headache/ 
 
Science | AAAS. (2017). The science of migraines. [online] Available at: http://www.sciencemag.org/news/2015/02/science-migraines

Science | AAAS. (2017). Why Do Women Get More Migraines? [online] Available at: http://www.sciencemag.org/news/2012/08/why-do-women-get-more-migraines
 
Van Hemert, S., Breedveld, A. C., Rovers, J. M. P., Vermeiden, J. P. W., Witteman, B. J. M., Smits, M. G., & de Roos, N. M. (2014). Migraine Associated with Gastrointestinal Disorders: Review of the Literature and Clinical Implications.Frontiers in Neurology, 5, 241. https://www.frontiersin.org/articles/10.3389/fneur.2014.00241/full 

Dai, Y., Wang, H., Wang, X., Kaye, A., Sun, Y (2017) Potential Beneficial Effects of Probiotics on Human Migraine Headache: A Literature Revie: Pain Physician; 20: E251-E255 • ISSN 2150-1149